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What is violence, abuse and neglect?

‘Violence, abuse and neglect’ is the umbrella term used by NSW Health for three types of interpersonal violence that are widespread in Australian communities: domestic and family violence; sexual assault; and all forms of child abuse and neglect. Children and young people with problematic or harmful sexual behaviour, who often present to NSW Health services, are also included. This is because they often have had personal experiences of violence, abuse and neglect and can be at heightened child protection risk.

If a person, including a child, is in immediate danger call Emergency Triple Zero: 000

In addition to NSW Health violence, abuse and neglect services (see below), 24 hour help and support for violence, abuse and neglect is available from:

What are Violence, Abuse and Neglect (VAN) Services and programs?

The health sector plays a crucial role in efforts to prevent, respond to, and minimise the impacts of violence, abuse and neglect and these issues are core business for NSW Health (Integration Prevention and Response to Violence, Abuse and Neglect Framework).

Although preventing and responding to violence, abuse and neglect is the responsibility of the whole health system, NSW Health has a network of VAN Services which have principal responsibility for responding to these issues (i.e. it is their key focus or activity). These services are:

  • Aboriginal Family Wellbeing and Violence Prevention Program (AFWVP)
  • Child Protection Counselling Services (CPCS)
  • Child Protection Units/Teams (CPUs)
  • Child Wellbeing Units (CWUs)
  • Domestic violence services
  • Education Centre Against Violence (ECAV)
  • Joint Child Protection Response Program (previously the Joint Investigative Response Teams or JIRTs), including the Joint Referral Unit (JRU)
  • Responses to children under 10 displaying problematic or harmful sexual behaviours (e.g. Kaleidoscope Sparks Clinic)
  • New Street Services (for children and young people aged 10-17 years and engaging in harmful sexual behaviours)
  • Sexual Assault Services (SAS)
  • Specialist Services for Children and Young People in Out-Of-Home Care (OOHC), including the OOHC Health Pathways Program
  • Whole Family Teams (WFTs)

Other key programs and roles that further support NSW Health’s VAN responses include:

  • Domestic Violence Routine Screening (DVRS) Program
  • hospital and community health-based social workers who play a critical role in providing psychosocial services for people and their families affected by violence, abuse and neglect (this is between 40-90 per cent of their role)
  • key inter-agency service responses including Safer Pathway Safety Action Meetings, which deliver coordinated responses to domestic and family violence victims at serious threat.

What is the COVID-19 virus (SARS-CoV-2-2019)?

COVID-19 is a new strain of coronavirus that has not been previously identified in humans. It was first identified in Wuhan, Hubei Province, China, where it has caused a large and ongoing outbreak. It has since spread more widely in China. Cases have since been identified in several other countries.

There is much more to learn about how COVID-19 is spread, its severity, and other features associated with the virus; epidemiological and clinical investigations are ongoing.

Outbreaks of new coronavirus infections among people are always a public health concern. The situation is evolving rapidly.

More information about COVID-19 is available at COVID-19 (Coronavirus).

Key messages about violence, abuse and neglect and COVID-19

  • All VAN Services provide essential public health services. Many people who have experienced, or are at risk of violence, abuse and neglect present to NSW Health services and are in need of psychological and physical care.
  • There are VAN Services in every district and in the Sydney Children’s Hospitals Network providing 24 hour integrated psychosocial (crisis counselling, information and support), medical and forensic assessment and treatment to people experiencing or impacted by violence, abuse and neglect.
  • Recent media coverage on the impacts of COVID-19 has identified concerns around the increased risks to people experiencing, or at risk of violence, abuse and neglect. For example, reports from China have highlighted that COVID-19 and self-isolation have increased experiences of domestic violence and increased neglect of children and vulnerable people. This is consistent with what the evidence tells us about how the risk and impacts of violence, abuse and neglect increase during and after natural and other disasters as usual routines and supports are disrupted.
  • The mental health implications of living through natural and other disasters can be cumulative and can intensify existing experiences of trauma. People’s complex coping responses to violence, abuse and childhood neglect, such as alcohol and other drug use, or the impacts on existing mental health issues, may also increase during times of natural and other disasters, requiring enhanced health care.
  • Given the increased risks in times of community crisis, it is important that NSW Health services continue to identify and respond to violence, abuse and neglect and avoid any disruption to the provision of specialist NSW Health VAN Services.
  • VAN Services and programs need to provide a comprehensive and consistent response to COVID-19 across the state. 

As the COVID-19 pandemic evolves, The Ministry will continue to assess the impact of the COVID-19 pandemic on VAN service delivery, and will issue further guidance as required.

Frequently asked questions (FAQs) about violence, abuse and neglect and COVID-19

General: maintaining operations and assessing and responding to COVID-19 risks

Should VAN Services and programs maintain operations in the context of COVID-19?

Yes. VAN Services and programs are essential services and should be maintained as close to normal as possible. VAN Services and programs will need to undertake local planning to ensure continuity of services and take into account, mitigate and adapt to any COVID-19 related risks to avoid disruption to services. This includes taking on new referrals and proceeding with client allocation and referral processes. This is particularly important when recognising that incidences of violence, abuse and neglect are anticipated to increase during the outbreak of COVID-19 and the introduction of physical distancing and isolation measures.

Should VAN Services identify if a client or potential client has or is at risk of having COVID-19 as standard practice during the COVID-19 pandemic?

Yes. A routine risk assessment should be conducted to assess COVID-19 risk. However, if a client or potential client meets the risk criteria they should still receive a VAN Service (refer to How should VAN Services prepare to respond to a client or potential client that has been screened at risk of having COVID-19?)

To help assess COVID-19 risk, NSW Health staff are to ask all clients or potential clients:

  • Have you returned to Australia from overseas in the last 14 days?
  • Have you been in close contact with a confirmed case of COVID-19 (i.e. novel coronavirus)?
  • Do you have a fever, cough, sore throat or shortness of breath?

If they answer yes to questions 1 and/or 2 they should be instructed to self-isolate (refer to: Self-isolation and mandatory quarantine).

If they answer yes to question 3 they should seek medical attention for COVID-19 (refer to: COVID-19 (Coronavirus)).

Please refer to NSW Health current testing advice for up-to-date risk criteria.

How should VAN Services prepare to respond to a client or potential client that has been screened at risk of having COVID-19?

VAN Services are essential services and should prepare to respond to this patient group by discussing local provision of PPE in their health settings and following the guidance of local Infection Prevention and Control staff as well as the wider public health advice as regularly updated. Case specific public health advice will be required in the case of a client or potential client that is or needs to self-isolate. VAN medical and forensic services should ensure attending staff follow PPE procedures, and the rapid, yet safe movement of the patient through Emergency Department and into appropriate isolation.

Please refer to:

More information about COVID-19 is available at NSW Government - COVID-19.

How should VAN Services collaborate with Emergency Departments during COVID-19?

VAN Service managers should liaise with Emergency Departments to ensure normal referral pathways into VAN Services (particularly 24 hour crisis services) are maintained and activated during the COVID-19 response to:

  • inform them of the heightened risks of violence, abuse and neglect at this time
  • help ease the pressure on Emergency Departments
  • ensure clients are not over-looked in any changes to normal triage processes in response to COVID-19.

Is a VAN Service still able to do a home visit in the context of COVID-19?

VAN Services should ensure local service guidelines and mitigation strategies are followed for assessing and managing risk. VAN Services should consider whether services can be safely provided without conducting home visits at this time.

Prior to conducting a home visit staff should ask clients:

If the client or potential client answers yes to any of these four questions, the VAN Service should not conduct a home visit however the client should still receive a VAN Service. For further information about how VAN Services should prepare to respond to this patient group, please refer to How should VAN Services prepare to respond to a client or potential client that has been screened at risk of having COVID-19?

More guidance for health professionals on home visiting in the context of COVID-19 is at Guidance for home visiting.

Additional precautions and infection control measures

Are there any additional infection control measures VAN Services should take in the context of COVID-19?

VAN Services are to strengthen normal infection control measures by:

  • adhering to physical distancing and hand hygiene measures
  • following respiratory hygiene and cough etiquette
  • Minimising the need for close contact, where possible. The definition of close contact is within the current case definition. Ideally during essential face to face appointments, practise physical distancing and keep greater than 1.5 metres distance between staff and patients and between staff.
  • Implementing standard precautions at both individual and service level, including for example enhanced environmental cleaning. Ensure use of PPE is in line with current transmission based precautions recommendations. Refer to the NSW Health website and the CEC COVID-19 website for the most up to date infection control advice.
  • Working from home may also be an alternative where face-to-face client services are not required, especially when work sites do not enable current physical distancing arrangements (e.g. shared, confined office space).
  • For further advice about How to manage COVID-19 in difference types of workplacesplease refer to Safe Work NSW.

For further information about crisis presentations to sexual assault services and child protection medical and forensic services, please refer to Should crisis presentations to sexual assault services and child protection medical and forensic services still be seen in the Emergency Department? and the Suggested Clinical Pathway – Offering Medical and Forensic Responses to Sexual Assault in the Context of COVID-19.

Is there a course that VAN Services Staff can undertake to support their use of PPE?

Yes. The Personal Protective Equipment for Combined Transmission-Based Precautions (Course Code: 294450660) is a new eLearning course that has been statewide mandated for all NSW Health staff. The Clinical Excellence Commission developed the course specifically for the COVID 19 response to enhance procedures for health staff for PPE. The module contains two videos that provide instructions for putting on and taking off PPE when applying combined transmission-based precautions in addition to standard precautions. The training duration is 15 minutes. Staff must complete the training within 4 weeks. The training will remain mandatory for the duration of the COVID-19 response.

Please direct any questions to Vesna Slepcev at vesna.slepcev@health.nsw.gov.au

What precautions should VAN staff at high risk of serious complications from COVID-19 infection take?

VAN service staff at high risk, including those staff who are pregnant, caring for elderly relatives, or with underlying health conditions, should consult with their local manager about risk mitigation strategies, including the reallocation of staff who are at high risk of serious complications from COVID-19 infection where appropriate, planning for crisis presentations at risk of COVID-19 infection, and local roster coverage considerations.

Medical and Forensic

A Suggested Clinical Pathway – Offering Medical and Forensic Responses to Sexual Assault in the Context of COVID-19 has been produced to guide medical and forensic service delivery. Please refer to this document for detailed guidance on infection control during medical and forensic consultations.

Can VAN Services only provide medical and forensic services to victims of violence, abuse and neglect who are reporting to NSW Police?

No. Medical and forensic examinations in NSW are provided in a health context and take place within general integrated health care provision, to optimise health and wellbeing. The restriction or refusal of services to victims of violence, abuse and neglect based on whether victims have reported or may report to Police is not supported, in general or during the COVID-19 response. VAN service restrictions do not align with NSW Health’s priorities of safety, wellbeing and crisis care and may also increase risk of infection, as victims may seek to address unmet health needs elsewhere, including through Emergency Departments (EDs).

Should crisis presentations to sexual assault services and child protection medical and forensic services still be seen in the Emergency Department?

It is important that NSW Health services continue to identify and respond to violence, abuse and neglect, and avoid any disruption to the provision of specialist medical and forensic services. However, some modifications to practice may be helpful to minimise time spent in EDs.

All crisis presentations must be medically triaged. This triage is usually provided through the ED, however during the COVID-19 response districts/networks may instead provide triage through a medical assessment by an appropriately qualified SAS/CPU medical forensic examiner at an alternative but appropriate service location. These qualifications include the capacity to determine whether the patient may need urgent medical and/or psychiatric care through the ED.

Districts and networks that have established alternative service locations with facilities for medical and forensic consultations outside the ED should direct patients to attend that facility during its opening hours for medical triage and a medical and forensic consultation. After-hours presentations should continue to go through the ED, rather than being held over until normal business hours. Alternate service locations should have procedures in place to recognise if a patient is deteriorating and respond to their medical needs.

Districts and networks that do not have appropriate alternative service locations for medical and forensic consultations should continue to see patients in the ED.

For services being provided in EDs, following medical triage, usual SAS/CPU patient journeys should be followed.

If the patient expresses concern about attending an ED due to the risk of contracting COVID-19, or because they belong to a vulnerable group, services should provide the patient with information about the risks and benefits of presenting to an ED for a consultation. Patients should not be discouraged from attending a health service, including an ED, for a sexual assault or child protection medical and forensic consultation and VAN services should endeavour to put in place measures, including reasonable service modifications where appropriate, to support patients to access these services. Further information is available in the Suggested Clinical Pathway – Offering Medical and Forensic Responses to Sexual Assault in the Context of COVID-19.

Should crisis presentations to sexual assault services and child protection medical and forensic services which occur after-hours be held over until normal business hours as part of the response to COVID-19?

No. Patients should be met as soon as possible by the rostered doctor and counsellor on-call and escorted from ED to SAS and/or CPU examination rooms or alternative service locations. This will help to move patients quickly through ED and help to reduce the time patients spend in hospital.

However, if a patient contacts a service prior to presenting to an ED and there are particular concerns about COVID-19, the service may offer the option to be seen during business hours if this is thought to help mitigate local risk. For instance, services who are seeing patients in community health settings during business hours may provide clients with the option to be seen in business hours. Patients offered this option should be provided with information about any benefits or risks of attending an ED and any risks of delaying the medical and forensic response, to ensure they are able to make an informed choice. If a patient makes an informed choice to delay attending, advice should be provided about how to reduce the risk of evidence loss.

Where should COVID-19 positive (or at risk) patients be seen?

When responding to a sexual assault presentation, districts/networks should adhere to existing arrangements and procedures in place for the triage and treatment of COVID-19 positive or at-risk patients.

For further information please refer to How should VAN Services prepare to respond to a client or potential client that has been screened at risk of having COVID-19?

Should the rationale for offering Early Evidence Kits (EEKs) to sexual assault crisis presentations be broadened as part of the response to COVID-19?

No. Early Evidence Kits (EEKs) are designed to complement but not replace full medical and forensic examinations, and must only be offered in specific circumstances outlined in the Responding to Sexual Assault (Adult and Child) Policy and Procedures.

Shifts in VAN service delivery in the context of COVID-19 are intended to reduce pressure on EDs without compromising service delivery for sexual assault and child physical abuse and neglect presentations. EEKs are usually conducted in EDs and providing an EEK in place of a full medical and forensic examination is unlikely to reduce pressure on EDs. The Ministry recognises there may be staff shortages as a result of the COVID-19 pandemic, and as per current policy related to delays for other reasons, an EEK may be offered if a medical forensic examiner is unavoidably delayed, and a full SAIK provided as soon as the examiner is available.

Should VAN services continue to respond to crisis presentations who have tested positive for COVID-19 or are probable or suspect cases?

Yes. As essential health services, VAN Services will continue to provide care to victims, which may include people suspected or confirmed to have COVID-19. VAN Services should prepare to respond to this patient group by ensuring local procedures and provision of relevant PPE are in place for their health settings. VAN Services providing a face-to-face response should ensure all attending staff follow appropriate screening, response and PPE procedures, have access to adequate PPE, and have been trained in the correct use of PPE.  

Detailed guidance on offering medical and forensic responses to patients who are suspected or confirmed to have COVID-19 is available in the Suggested Clinical Pathway – Offering Medical and Forensic Responses to Sexual Assault in the Context of COVID-19​.

For further details about Infection Prevention and Control related to the COVID-19 in hospital settings please refer to COVID-19 Infection Prevention and Control: Advice for Health Workers.

More detail on offering medical and forensic responses to patients who are suspected or confirmed to have COVID-19, including use of telehealth within the hospital, is available in the Suggested Clinical Pathway – Offering Medical and Forensic Responses to Sexual Assault in the Context of COVID-19​.

Can telehealth be used for medical and forensic consultations?

An in-person response should remain standard practice for medical and forensic consultations, and telehealth offered only in limited circumstances where no face-to-face options are available or where staff unexpectedly do not have access to the appropriate equipment (including PPE) or training in the use of PPE to meet local district/network infection control protocols in providing a face-to-face response.

Telehealth options may be used only after undertaking a risk assessment which includes assessment of COVID-19 infection risk, violence, abuse and neglect and other safety risks, and confidentiality considerations. For further detail on appropriate use of telehealth in VAN services please refer to Telehealth.

Examples of where telehealth may be appropriate include:

  • to conduct initial telephone screening of a patient for COVID-19 risks or vulnerabilities, where the patient has contacted the service prior to attending
  • to conduct a risk assessment/triage for urgent mental and physical health needs if the patient is in a group that is vulnerable to serious illness if contracting COVID-19 (such as people aged 70 years and over, people aged 65 years and over with chronic medical conditions, people with compromised immune systems, and Aboriginal and Torres Strait Islander people over the age of 50 with chronic medical conditions), has concerns about COVID-19, and chooses not to attend a Health facility for a medical and forensic consultation

Where the patient is a suspected or confirmed COVID-19 case, or meets the criteria for a probable or suspect case (See Coronavirus Disease 2019 (COVID-19)), the medical and forensic examiner may choose to use telehealth within the hospital to complete the patient history section of the MFER in order to reduce transmission risk during a lengthy consultation. This approach should only be used with the patient’s consent, and after the examiner and SAS counsellor have performed a risk assessment of the suitability for telehealth for the patient.

More detail on offering medical and forensic responses to patients who are suspected or confirmed to have COVID-19, including use of telehealth within the hospital, is available in the Suggested Clinical Pathway – Offering Medical and Forensic Responses to Sexual Assault in the Context of COVID-19​​.​

What Personal Protective Equipment (PPE) should be worn during a medical and forensic consultation?

Medical and forensic examiners, SAS counsellors and other Health staff present during a medical and forensic consultation should follow current advice from their district/network regarding use of PPE.

As a guide, when providing a medical and forensic consultation to a patient who is a suspected or confirmed COVID-19 case, the medical and forensic examiner should follow droplet and contact PPE precautions, as set out in the Clinical Excellence Commission’s COVID-19 Infection Prevention and Control: Advice for Health Workers (ie: gown, gloves, eye protection and surgical mask). Airborne precautions (eg: use of a P2/N95 mask) are not required, unless it is the local district/network policy to follow such precautions for high risk patients or an aerosol generating procedure will be undertaken during the consultation.1

Subject to local district/network policy and availability of PPE, examiners conducting a medical and forensic consultation where the patient is not a suspected or confirmed COVID-19 case, but where other risk factors are present (for example, the patient is living or working in a high-risk setting, or the health service is in an identified area for increased testing and surveillance for COVID-19) may also consider following contact and droplet PPE precautions, and advising those present in the examination room to do so.

Please note that the gown and gloves supplied in the SAIK DNA decontamination pack meets the PPE standard. Clean gloves may be used during a medical and forensic consultation if there are not sufficient DNA-free gloves to meet PPE requirements.

Further information on PPE is available in the Suggested Clinical Pathway – Offering Medical and Forensic Responses to Sexual Assault in the Context of COVID-19.

Can a patient’s support person be in the room during a medical and forensic consultation?

Where a patient is not a susected or confirmed COVID-19 case, districts/networks should follow their usual policies regarding the presence of support persons during a medical and forensic consultation. Physical distancing rules should be adhered to wherever possible. The support person/s should be screened for COVID-19 risk and their presence refused if they are unwell with flu-like symptoms.

Where a patient is COVID-19 positive or a probable or suspect case, the number of support persons should be limited to one, or none if possible, and physical distancing rules should be followed. The examiner should discuss support options with the patient and support person, including asking the support person to provide auditory support from outside the room or outside a 1.5 metre radius. The support person should be provided with appropriate PPE in accordance with local procedures and supervised to ensure correct donning and doffing of PPE if the person stays within the 1.5 metre zone.

Should oral swabs be used instead of oral rinses?

An oral rinse (as well as a peri-oral swab) is not classified as an aerosol generating procedure, and should continue to be taken as part of a medical and forensic consultation where there has been an oral assault or an oral rinse is otherwise indicated in the NSW Police and NSW Health guidelines for the collection of forensic specimens from complainants and suspects. An oral rinse has a higher sperm and DNA detection rate than an oral swab 2.

Can COVID-19 be transmitted through urine, semen or vaginal fluids?

There is evidence that people may shed the virus via rectal route and viral RNA is detectable in faecal samples from suspected cases. At this stage, it is unclear whether COVID-19 can also be transmitted through urine, semen or vaginal fluids, although emerging evidence suggests this is unlikely 3. Nevertheless, it is safest to assume that COVID-19 can be transmitted the genito-urinary tract and use appropriate infection control measures in the collection and handling of all samples, regardless of COVID-19 status.

Advice on infection control in sample collection is available in the CEC fact sheet COVID-19 Infection Prevention and Control Advice for Health Workersand in the Suggested Clinical Pathway – Offering Medical and Forensic Responses to Sexual Assault in the Context of COVID-19​.

Should verbal consent be taken on the MFER if a patient is COVID-19 positive or at-risk?

Wherever possible, the patient should sign the relevant pages of the MFER. If a patient is a suspected or confirmed COVID-19 case, the patient should be asked to don gloves or wash their hands (depending on what is appropriate based on the examination process and the need to minimise opportunities for DNA transfer) before signing the relevant pages of the MFER.

If it is not possible for the patient to sign the MFER, or patient handling of the MFER does not align with local infection control procedures, verbal consent should be taken. Verbal consent should be provided in the hearing of two NSW Health staff. The medical and forensic examiner should document the verbal consent in the MFER, including the name of the second NSW Health worker. This information should also be documented in the patient’s medical notes, with the reason verbal consent was provided.

Is the standard forensic clean sufficient for COVID-19 infection control?

No. A standard forensic clean is not sufficient and a more extensive clean of the room may be required for infection control for COVID-19. For more information on cleaning and disinfection, see Coronavirus (COVID-19) Environmental cleaning and disinfection principles for health and residential care facilities.

How should samples be packaged to ensure they are safe to transport?

Samples should be labelled, sealed and packaged into a Sexual Assault Examination Kit (SAIK) or Early Evidence Kit (EEK) following instructions within the kit, the Medical Forensic Examination Record (MFER), and local policies. These packaging instructions are designed to ensure that samples are correctly preserved for later testing and deviating from these may compromise the integrity of the samples.

The Forensic & Analytical Science Service (FASS) has completed a risk assessment and recommends no changes to current specimen collection practice for patients at high risk or positive for COVID-19. FASS has introduced additional infection control procedures to minimise the risk to staff from all sample types, including oral rinses.

Where the patient is a suspected or confirmed COVID-19 case or where the health service is located in an area for increased testing and surveillance for COVID-19, the service should consider adopting additional infection control protocols during packaging to avoid contamination from the outside of samples. Further advice is available in the CEC fact sheet COVID-19 Infection Prevention and Control Advice for Health Workers. Specific further guidance on packaging for sexual assault medical forensic examinations is available in the Suggested Clinical Pathway – Offering Medical and Forensic Responses to Sexual Assault in the Context of COVID-19​.

Telehealth

What are the risks of using telehealth modalities for clients who are experiencing violence, abuse and neglect in the context of COVID-19?

In response to COVID-19 and the introduction of physical distancing and isolation measures, many services are reviewing and adapting the way they deliver services. This will likely lead to services reducing the amount of face-to-face contact they have with clients and moving towards the provision of services via telehealth, including the use of more phone and online services.

However, rushing to change practice and adopt technology quickly without time for more thorough planning and evaluation can significantly compromise safety and privacy of survivor victims’ of violence, abuse and neglect and their ability to access services.

For example, the delivery of services via telehealth can leave a “trail” and provide increased opportunities for perpetrators of violence to monitor victims’ activities and conversations within the home, and an increased risk of technology facilitated abuse, which can include tracking the movement and activities through devices. Where perpetrators become aware of disclosures of violence, abuse and neglect and subsequent interventions there can be increasing risk to survivors. In terms of access, it can be a lot harder for survivors / victims to get privacy in order to safely make and receive phone calls or look up information about support.

Any transition towards delivering services to people experiencing violence, abuse and neglect via telehealth modalities should recognise and seek to mitigate against these risks.

For further guidance, please refer to NSW Health’s VAN and telehealth guidance.

Should telehealth be adopted by VAN Services and programs as standard practice in the context of COVID-19?

Telehealth should not be adopted as standard practice for the provision of VAN services unless it is accompanied with comprehensive clinical guidance about: how to appropriately provide telehealth services that supports the identification, management and monitoring of risks to patients’ safety, privacy, and confidentiality and to service integrity. A local telehealth protocol should be developed to provide clinical guidance.

For further information about what to consider when developing local telehealth protocols and guidance, please refer to What are some of the key considerations when developing local telehealth protocols and guidance?

When should I use telehealth facilities for clients in the context of COVID-19?

Telehealth options may be used in individual circumstances. However, these options should only be adopted once local protocols are in place, and after undertaking a risk assessment, which determines that the use of telehealth will not place the client and their family at greater risk. This risk assessment should not only take into account risks related to COVID-19 but also the  heightened risks to privacy and the emotional, psychological, physical and cultural safety of clients, families and carers experiencing or at risk of experiencing violence, abuse and neglect.

What are some of the key considerations when developing local telehealth protocols and guidance in the context of COVID-19?

Local telehealth protocol guidance should adhere to the Agency for Clinical Innovation Telehealth in Practice Guide and NSW Health’s VAN and telehealth guidance, remove any barriers to access, and account for and mitigate the heightened risks to privacy and the emotional, psychological, physical and cultural safety of clients, families and carers where telehealth services are proposed. Protocols should include consideration of, but not limited to:

  • Procedures to re-assess risks, and review and update safety plans to account for changes or potential changes related to COVID-19.
    • This should account for and provide strategies for risks arising due to COVID-19 and physical distancing measures. It should also seek to understand the preferred and safest contact methods for a client, including whether telehealth is safe and appropriate and how to best plan for potential changes related to this, including plans should the client need to self-isolate. If possible, face to face services should prioritise this work with clients. A range of resources can be accessed to support discussions with clients about online safety, as well as apps that work to help protect the online safety of users. Further information can be found at:
  • Specific risks associated with the use of different technologies.
  • Guidance for staff about how to gain informed consent and communicate limits to confidentiality
  • Guidance about update changes in local referral pathways and support services for people experiencing violence, abuse and neglect. This information should be communicated with all staff and all health services are encouraged to speak with specialist VAN Services and practitioners to discuss and confirm local consultation and referral pathways.
  • Guidance for staff about how to plan for and check that clients’ are in a position to speak safely and privately with them at the beginning of telehealth sessions. This should include procedures to promote safety and privacy when undertaking private sessions with children under 16 and guidance about how to create opportunities for joint work with children and parents toward the end of sessions as appropriate. It should also ensure that there is a responsible caregiver available to attend to emotional needs of the child following the session.
  • Practical guidance for staff on establishing strategies with clients for debriefing and further supports to manage any distress following sessions.

Please note that the resources highlighted above are for general guidance only. Services need to adhere to NSW Health policy on the use of online secure platforms for telehealth health services and services introducing telehealth responses and should consult with the relevant District/Network Telehealth contacts and discuss the specific VAN related risks. For further details refer to ACI - Telehealth.

For further detail about the risks related to using telehealth for clients, please also refer to NSW Health’s VAN and telehealth guidance and What are the risks of using telehealth modalities for clients who are experiencing violence, abuse and neglect in the context of COVID-19?

Should Domestic Violence Routine Screening be conducted by teleheath in the context of COVID-19?

No. NSW Health services participating in the DVRS should continue to adhere to the current policy requirement that routine screening only be conducted through face to face interactions.

Conducting DVRS in front of others may increase risks to women experiencing domestic violence. For example, if a partner who is using violence is present during the screening or someone who is present during the screening reports back to a partner who is using violence.

However, services should continue to respond appropriately to any disclosures or concerns about violence, abuse and neglect. Services being delivered through a mix of telehealth and face to face modalities should prioritise routine screening for domestic violence (DV) during face to face contacts.

Screening services should liaise with specialist NSW Health VAN Services to confirm local consultation and referral processes to support risk assessment, safety planning and other assistance for victims to ensure that they can support ongoing responses to domestic and family violence during face to face or telehealth interventions.

Please also refer to NSW Health COVID-19: Guidance for Child and Family Health Services for additional information about recommended alternative modes of care for Child and Family Health service delivery.

Will there be any changes to reporting data on DVRS KPIs?

No, the Ministry of Health’s monitoring of KPIs in this area will take into account the fact that the shift toward telehealth to support COVID-19 control measures will impede the capacity of districts to meet their Domestic Violence Routine Screening KPIs. We note that current reports do not exclude services that are not provided in person, however interim change requests to reports are not recommended as there is work already underway to address this. In the interim, services unable to screen women as they are using telehealth should record the reason for not screening as “Other” on the screening form.

Where can I find additional guidance on violence, abuse and neglect and telehealth?

NSW Health has developed VAN and telehealth guidance to support health services and practitioners address and respond to the increased safety risks that people experiencing violence, abuse and neglect experience when accessing support via telehealth.

Intra and inter agency and organisational work

Will the Child Protection Helpline and the NSW Health Child Protection Wellbeing Units (CWUs) maintain operations during the COVID-19 Pandemic?

The Child Protection Helpline and the NSW Health Child Wellbeing Units (CWUs) have developed business continuity plans to ensure they maintain operations while navigating the Covid-19 environment. However, some staff are working remotely and may have less capacity to take direct calls. We therefore strongly encourage Health workers to:

  • Use eReporting (instead of phoning reports) to both the Child Protection Helpline and to our NSW Health CWUs
    • It is important that any staff who may need to report and are not already registered for eReporting complete their registration now. Sign up to eReport.
  • Complete the Mandatory Reporter Guide, when you have sufficient information about any abuse, neglect or wellbeing concerns.
  • This will assist in determining the need to report to the Helpline or CWU and to access the eReporting link.
  • Start your eReport (text field) with the word URGENT if indicated.
    • Aim to convey all key information, including child/young person/family details, as well as the nature of the abuse/harm and impact on the child/young person. This will assist in triaging at the Helpline or CWU.
  • When seeking advice or child protection history information, email the NSW Health CWUs, as an alternative to phoning:
    • Southern CWU: SCHN-CWU@health.nsw.gov.au
      Receive contacts from workers (including specialty Network staff) geographically located in SCH, SLHD, NSLHD, SESLHD, ISLHD, MLHD and SNSWLHD.
    • Northern CWU: HNELHD-NCWU@health.nsw.gov.au
      Receive contacts from workers (including specialty Network staff) geographically located in CCLHD, HNELHD, MNCLHD and NNSWLHD
    • Western CWU: WNSWLHD-ChildWellbeingUnit@health.nsw.gov.au
      Receive contacts from workers (including specialty Network staff) geographically located in CHW, WSLHD, SWSLHD, NBMLHD, WNSWLHD and FWLHD

Please be aware that if staff call the CWU they may be asked to leave a message. CWU staff are checking and responding to messages, eReports and emails then calling health workers back as soon as practicable.

Safety Action Meetings: How should I participate in Safety Action Meetings (SAM) during the COVID-19 pandemic?

All Safety Action Meetings across NSW are being conducted via Audio Video Link (AVL), Skype or teleconference until further notice. The local SAM is responsible for ensuring that all members are supported and able to attend via AVL, Skype or teleconference.

All NSW Health representatives or their delegates should participate in SAMs using one of these modes and should liaise with their local SAM to determine the AVL or teleconference capabilities of the meeting and decide how they can participate and contribute to the meeting remotely. A teleconference phone should be available in the SAM meeting room and should allow multiple SAM members to call in at once if needed. A normal landline or mobile phone on ‘speaker’ is not advised.

When attending remotely, SAM members should:

  • follow the same guidelines as if attending in person i.e. sign the confidentiality agreement and be in a private room for confidentiality reasons
  • inform the SAM Chair when they cannot hear other participants clearly
  • state their name and agency when contributing in the SAM when there are multiple remote attendees
  • mute themselves when not speaking to minimise background noise.

Please note that Legal Aid NSW has cancelled the Safety Action Meeting training scheduled for Wednesday, 29 April 2020 in Narooma and Wednesday, 20 May 2020 in Sydney.

Family Referral Services (FRS): Can I still refer clients to FRS in the context of COVID-19?

FRS deliver a range of supports to vulnerable children, young people and families, ranging from information and referral support through to case coordination for clients with multiple and complex needs. FRS are delivered statewide by a range of non-government organisations.

All FRS providers continue to operate during the COVID-19 pandemic. However, to ensure the health of clients and staff, the majority of inbound referrals and assessments are occurring via telephone. Where possible, NSW Health workers are encouraged to make warm referrals to FRS at this time.

To make a referral to the FRS, visit the FRS website to find your local provider.

Should NSW Health workers experience any difficulty accessing the FRS during the COVID-19 pandemic, please contact the Child Protection and Wellbeing Team via: MOH-PARVAN@health.nsw.gov.au

Victims Services: How are Victim Services in the NSW Department of Communities and Justice operating their services for victims of domestic and family violence in the context of COVID-19?

Victims Services provides support to victims of violent crime in NSW including counselling and financial assistance. Victims Services will continue to operate their phone lines during the Pandemic however to reduce risk of infection they are limiting face-to-face contact and have closed their office in Parramatta until further notice.

If you need to contact Victims Services, you can call Monday-Friday, 9am to 5pm via the following hotlines:

  • Victims Access Line: 1800 633 063
  • Aboriginal Contact Line: 1800 019 123
  • Families and Friends of Missing Persons Unit: 1800 633 063
  • Specialist Victims Support Service: 1800 633 063

You can also continue to lodge online forms for victims support.

Access to Reproductive Health Services in the context of COVID-19

Access to reproductive health services is a whole of sector shared response by the public health system, private providers, primary care and accredited non−government organisations.

Family Planning NSW provides comprehensive support and advice on sexual and reproductive health through Talkline at 1300 658 886.

Statewide information and support for women seeking a termination of pregnancy is also available through the NSW Pregnancy Options Helpline 1800 131 231 and through the NSW Health website at Pregnancy options.

Courts: Will court hearings relating to domestic violence and sexual assault be delayed due to COVID-19?

Some court services and processes are changing to respond to the COVID-19 pandemic and there may be some delays in proceedings.

  • New jury trials are temporarily suspended in the District and Supreme Courts. Current trials, where a jury has already been selected and empanelled, will continue.
  • On and from 1 April 2020, the District Court of NSW will temporarily suspend New Judge alone trials, sentence hearings, Local Court Appeals, arraignments and readiness hearings, where the defendant is not in custody. This temporary suspension will be reviewed on 1 May 2020. The Court will continue to hear to the extent and for as long as possible, consistent with health advice, all criminal matters where the defendant is in custody (with the exception of new jury trials).
  • NSW Local Courts have new arrangements in place relating to domestic and personal violence proceedings. Proceedings relating to Apprehended Violence Orders (AVOs) between 1 April and 1 May will be adjourned, but arrangements to extend provisional AVOs are in place. Detail on these arrangements is available at Memorandum – COVID-19 Arrangements (No. 7) Management Of Domestic And Personal Violence Proceedings During Pandemic Period.

More detailed information and updates on the operation of individual courts and types of proceedings can be accessed through the Department of Communities and Justice COVID-19 site.

Information sharing

Can NSW Health services share information about COVID testing or positive cases when there are concerns about the safety, welfare or wellbeing of children (including unborn children)?

The basis for providing information about positive COVID-19 testing or results under Chapter 16A of the Children and Young Person (Care and Protection) Act 1998 is the same as any other information shared under these provisions.

That is, to share COVID-19 information it needs to be for the purposes of making any decision, assessment or plan or to initiate or conduct any investigation, or to provide any service, relating to the safety, welfare or well-being of individual or classes of children or young persons or manage risk to a child or young person.

In considering any request under Chapter 16A, please apply the same considerations as you would normally, including:

  • Is the request from a prescribed body as per 16A?
  • Has the requesting body indicated why they could not seek consent to share the health information from their client directly?
  • Does the requesting body need to know a person's COVID-19 status to conduct an investigation/provide a service/make a decision relating to the safety, welfare or wellbeing of the named child or young person? Examples of where this may apply include:
    • There are concerns around medical neglect, characterised by a caregiver's failure to provide appropriate medical care in the context of suspected COVID-19
    • An out-of-home care placement is being arranged for a child.

Does the provision of information assist the prescribed body to manage any risk to the child or young person (or class of children or young persons) that might arise in the recipient's capacity as an employer or designated agency? e.g. COVID-19 status of a foster carer.

The Public Health (COVID-19 Restrictions on Gathering and Movement) Order 2020 permits disclosing information to another government agency if the Health Service considers it necessary to do so for the purposes of protecting the health or welfare of members of the public. The public would include that government agency’s staff who undertake visits in a person’s home. e.g. DCJ.

If there is a serious and imminent threat to the life, health or safety of the individual or another person, information could be shared under the Health Records and Information Privacy Act 2002, including to a NGO.

Additional resources

The NSW Health website provides information on COVID-19 for health professionals: COVID-19 (Coronavirus).

A number of resources about COVID-19 have been developed to provide information for and support to Aboriginal and Torres Strait Islander people, including:

Resources are also available for NSW Health staff responding to violence, abuse and neglect in the context of COVID-19. Some of these resources were provided in the special bushfire edition of the PARVAN adVANsing newsletter in February and others have been developed specifically in response to COVID-19. These resources may be of use in planning responses to COVID-19: 

NSW Health also recognises that professional practice of health workers often intersects with personal experiences of violence, abuse and neglect, and that during this time of increased distress, NSW Health staff have access to a range of supports in addition to those including but not limited to domestic and family violence leave provisions and Employee Assistance Programs. Employees are encouraged to speak with their supervisor or human resources team for further information and support.

Notes

  1. Aerosol-generating procedures (AGPs) include tracheal intubation, non-invasive ventilation, tracheotomy, cardiopulmonary resuscitation, manual ventilation before intubation, bronchoscopy and collection of induced sputum.
  2. Nittis, M., Franco, M. and Cochrane, C. (2016) New oral cut-off time limits in NSW Journal of Forensic and Legal Medicine 44: 92-97. https://doi.org/10.1016/j.jflm.2016.09.006
  3. Qiu et al (2020) “SARS-CoV-2 is not detectable in the vaginal fluid of women with severe COVID-19 infection” Clinical Infectious Diseases: https://doi.org/10.1093/cid/ciaa375
    Song et al (2020) “Detection of 2019 novel coronavirus in semen and testicular biopsy specimen of COVID-19 patients” MedRxiv preprint: https://doi.org/10.1101/2020.03.31.20042333

Document information

NSW Health is recommending that this guidance is used by those providing services for people who are experiencing or at risk of experiencing violence, abuse and neglect, including by NSW Health Violence Abuse and Neglect (VAN) Services.

For further questions about this fact sheet, please email: MOH-PARVAN@health.nsw.gov.au.

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Current as at: Monday 13 July 2020
Contact page owner: Health Protection NSW